title: Brain metastases in women with epithelial ovarian cancer: multimodal treatment including surgery or gamma-knife radiation is associated with prolonged survival.
abstract: OBJECTIVE
  To explore the impact of treatment modality on survival in patients with brain metastases from epithelial ovarian cancer.
  
  
  METHODS
  We conducted a retrospective review of cases of ovarian cancer with brain metastases treated at institutions in three countries (Canada, China, and India) and conducted a search for studies regarding brain metastases in ovarian cancer reporting survival related to treatment modality. Survival was analyzed according to treatment regimens involving (1) some form of surgical excision or gamma-knife radiation with or without other modalities, (2) other modalities without surgery or gamma-knife radiation, or (3) palliation only.
  
  
  RESULTS
  Twelve patients (mean age 56 years) with detailed treatment/outcome data were included; five were from China, four from Canada, and three from India. Median time from diagnosis of ovarian cancer to brain metastasis was 19 months (range 10 to 37 months), and overall median survival time from diagnosis of ovarian cancer was 38 months (13 to 82 months). Median survival time from diagnosis of brain metastasis was 17 months (1 to 45 months). Among patients who had multimodal treatment including gamma-knife radiotherapy or surgical excision, the median survival time after the identification of brain metastasis was 25.6 months, compared with 6.0 months in patients whose treatment did not include this type of focused localized modality (P = 0.006). Analysis of 20 studies also indicated that use of gamma-knife radiotherapy and excisional surgery in multi-modal treatment resulted in improved median survival interval (25 months vs. 6.0 months, P < 0.001).
  
  
  CONCLUSIONS
  In the subset of patients with brain metastases from ovarian cancer, prolonged survival may result from use of multidisciplinary therapy, particularly if metastases are amenable to localized treatments such as gamma-knife radiotherapy and surgical excision.
authors.affiliation: Obstetric and Gynecologic Department, Sichuan University Huaxi Second Hospital, Sichuan Province, China.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Niu
authors.affiliation: Surgical and Gynecologic Oncology, Amrita Vishwavidyapeetham, Kochi, Kerala, India.
authors.forename: Anupama
authors.initials: A
authors.lastname: Rajanbabu
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital/Segal Cancer Centre/McGill University, Montreal QC.
authors.forename: Megan
authors.initials: M
authors.lastname: Delisle
authors.affiliation: Oncology Department, Sichuan University Huaxi Hospital, Sichuan Province, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Peng
authors.affiliation: Surgical and Gynecologic Oncology, Amrita Vishwavidyapeetham, Kochi, Kerala, India.
authors.forename: Dehannathuparambil K
authors.initials: DK
authors.lastname: Vijaykumar
authors.affiliation: Department of Medical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Kochi, Kerala, India.
authors.forename: Keechilattu
authors.initials: K
authors.lastname: Pavithran
authors.affiliation: Obstetric and Gynecologic Department, Sichuan University Huaxi Second Hospital, Sichuan Province, China.
authors.forename: Yukuan
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital/Segal Cancer Centre/McGill University, Montreal QC.
authors.forename: Susie
authors.initials: S
authors.lastname: Lau
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital/Segal Cancer Centre/McGill University, Montreal QC.
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gotlieb
authors.affiliation: Division of Gynecologic Oncology, Jewish General Hospital/Segal Cancer Centre/McGill University, Montreal QC.
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Press
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy*; D000077216:Carcinoma, Ovarian Epithelial; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000628:therapy*; D016634:Radiosurgery; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: brain metastases; gamma-knife radiotherapy; ovarian cancer; treatment modalities